Abstract

More than 3.2 million stillbirths occur globally each year, yet stillbirths are largely
invisible in global data tracking, policy dialogue and programme implementation. This
mismatch of burden to action is due to a number of factors that keep stillbirths hidden,
notably a lack of data and a lack of consensus on priority interventions, but also
to social taboos that reduce the visibility of stillbirths and the associated family
mourning. Whilst there are estimates of the numbers of stillbirths, to date there
has been no systematic global analysis of the causes of stillbirths. The multiple
classifications systems in use are often complex and are primarily focused on high-income
countries. We review available data and propose a programmatic classification that
is feasible and comparable across settings. We undertook a comprehensive global review
of available information on stillbirths in order to 1) identify studies that evaluated
risk factors and interventions to reduce stillbirths, 2) evaluate the level of evidence
for interventions, 3) place the available evidence for interventions in a health systems
context to guide programme implementation, and 4) elucidate key implementation, monitoring,
and research gaps. This first paper in the series outlines issues in stillbirth data
availability and quality, the global epidemiology of stillbirths, and describes the
methodology and framework used for the review of interventions and strategies.